Difference between revisions of "UCD Cryo A-fib"

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==Open==
 
==Open==
 +
 +
*EP Pack
 +
*Flexcath
 +
*28mm Arctic Advance
 
*Probe Cover
 
*Probe Cover
−
*Ice Cover - Shockwave
+
*2 - Ice Cover - Shockwave
 
*Copilot
 
*Copilot
 
*Manifold + dump bag
 
*Manifold + dump bag
 
*Smart Ablate Tubing
 
*Smart Ablate Tubing
−
*EP pack
 
 
*Micropuncture
 
*Micropuncture
 +
*20ml syringes 2-4
 +
*A-line set
 +
*Pressure transducer kit x3
 
*7F locking
 
*7F locking
 
*8F locking
 
*8F locking
−
*8.5 Nonlocking
+
*8.5 Non-locking
−
*Flexcath
+
*6fr CRD 2 quad
−
*6fr JSN quad
+
 
−
*28mm Arctic Advance
+
 
−
*Dynamic XT steerable quad
 
  
 
{| class="wikitable"
 
{| class="wikitable"
Line 22: Line 27:
 
!Munir
 
!Munir
 
|-
 
|-
−
|Achieve 20mm
+
|'''Stockroom'''
−
|Achieve 15mm
+
|
 +
|
 +
|
 +
|-
 +
|Versacross D0
 +
|Versacross D1
 +
|
 +
|
 +
|-
 +
|Soundstar 10Fr
 +
|Soundstar 8Fr
 +
|
 +
|
 +
|-
 +
|DecaNav D
 +
|DecaNav F
 
|
 
|
 
|
 
|
 
|-
 
|-
−
|Long 11fr
+
|
−
|Long 9fr
+
|
 
|
 
|
 
|
 
|
 
|-
 
|-
−
|14fr non-locking
+
|'''Lab'''
 
|
 
|
 
|
 
|
 
|
 
|
 
|-
 
|-
−
|Versacross D0
+
|Octaray D 2-2-2
−
|Versacross D1
+
|Octaray F 3-3-3
 
|
 
|
 
|
 
|
 
|-
 
|-
−
|Soundstar 10fr
+
|Dynamic XT steerable quad
−
|Soundstar 8fr
+
|CRD 2 Quad
 
|
 
|
 
|
 
|
 
|-
 
|-
−
|DecaNav D
+
|Achieve 20mm
−
|DecaNav F
+
|Achieve 15mm
 
|
 
|
 
|
 
|
 
|-
 
|-
−
|Octaray D 2-2-2
+
|Long 11Fr
−
|Octaray F
+
|Long 9Fr
 +
|
 
|
 
|
 
|-
 
|-
 +
|14fr non-locking
 +
|Zero Gravity drape
 
|
 
|
−
|Gg
 
 
|
 
|
 
|-
 
|-
 
|
 
|
 +
|
 +
|
 +
|
 +
|-
 +
|'''Standby'''
 +
|colspan = 3 |''If needed for touch up post cryo or for redo afib''.
 +
|-
 +
|Smart touch thermocool STSF DF
 +
|Smart touch thermocool ST FJ
 
|
 
|
 
|
 
|
 
|-
 
|-
 
|
 
|
 +
|Perclose x1
 +
Vascade x3
 
|
 
|
 
|
 
|
 
|}
 
|}
  
 +
===Cables===
  
−
19. Smart touch thermocool STSF FJ - Srivatsa, STSF DF - Pezeshkian
+
*Achieve cable
−
a. If needed for touch up post cryo or for redo afib
+
*Electrical umbilical cable
−
Cables
+
*Coaxial umbilical cable
−
 
+
*DecNav cable
−
 
+
*Pentaray cable
−
14. JSN quad 6F
+
*Quad cable x 2
−
 
+
*Abalator cable
−
15. Soundstar 8F- Srivatsa, 10F - Pezeshkian
 
−
 
 
−
16. Artic Advance balloon 28mm
 
−
 
 
−
17. CRD2 quad Only sirvals
 
  
−
18. Dynamic XT steerable quad
+
==Procedure (tech)==
 +
===Pre===
 +
Read [[UCD EP Role]] for pre and post procedural steps.
 +
*Include CMAP when patching for phrenic pacing
 +
**Cable located in C block #31-32
 +
**Attach alligator clips to patches
 +
*Set up pressure lines
 +
**Double spike Hep saline bag under pressure
 +
**Flush and connect blue pressure to transducer closest to patient on rack (P1)
 +
*Zero A-line
 +
*Assist with hooking up
 +
**Vascular US
 +
**EP cables
 +
***Achieve to pin block Blue 1-10
 +
***Deca nav to Deca
 +
***His Quad to Quad B (OK to unplug pin block quad plug)
  
 +
===During case===
 +
*Open ablation window on live screen
 +
**right click in ablation window to change ablator.
 +
**Check dial for correct ablator.
 +
*Check that ablation switch behind ablation consoles is set to "Cryo"
 +
*Physician will place catheters and access LA.
 +
*Be ready for backup pacing post cardioversion (usually HisD)
 +
*Measure LA pressure
 +
*Measure conduction intervals
 +
*Once Cryo ballon is in LA and ablation starts do the following:
 +
**Save and label freeze frame of fluoro with location of freeze and ablation number ex: "LUPV Cryo #1" copy this text and save
 +
**Monitor ablation sequence
 +
**After ablation ends, record ablation data including copied text to Ablation End log entry comment section ex: "LUPV Cryo #1 180sec -45C"
 +
***If esophagus temp is affected, record this temp also "23C esoph"
 +
**EP study is conducted during Cryo ablation phase of procedure
 +
***Atrial Wenckebach, Atrial ERP, and VERP
 +
**When phrenic nerve is involved. Prepare to pace CMAP
 +
***Channel 4 800msec, 25mA
 +
***When freeze is initiated, come on pacing as temp passes 0C
 +
***When thawing, come off pacing as temp passes 0C
  
−
20. Achieve cable
+
==Procedure (scrub)==
−
21. Electrical umbilical cable
+
===Pre===
−
22. Coaxial umbilical cable
+
*Label pressure lines
−
23. DecNav cable
+
**Blue - Transseptal line connected to P1. Swapped to manifold during cryo ablation.  
−
24. Pentaray cable
+
**Yellow - not transduced connected to flex cath sheath.  
−
25. Quad cable x 2
+
**No color - used for Octaray drip. Keep manifold on table.  
−
26. Abalator cable
+
**A-line setup. Pre labeled red. Connects to sheath for act draws.  
 +
*Setup manifold
 +
**Cap 2 middle ports for Srivasta. No dump bag
 +
**Position 1 connects to blue pressure line.  
 +
*Position 4 pass off spike for pressurized saline.

Latest revision as of 20:34, 26 October 2023

Open

  • EP Pack
  • Flexcath
  • 28mm Arctic Advance
  • Probe Cover
  • 2 - Ice Cover - Shockwave
  • Copilot
  • Manifold + dump bag
  • Smart Ablate Tubing
  • Micropuncture
  • 20ml syringes 2-4
  • A-line set
  • Pressure transducer kit x3
  • 7F locking
  • 8F locking
  • 8.5 Non-locking
  • 6fr CRD 2 quad


Pezeshkian Srivatsa Cortez Munir
Stockroom
Versacross D0 Versacross D1
Soundstar 10Fr Soundstar 8Fr
DecaNav D DecaNav F
Lab
Octaray D 2-2-2 Octaray F 3-3-3
Dynamic XT steerable quad CRD 2 Quad
Achieve 20mm Achieve 15mm
Long 11Fr Long 9Fr
14fr non-locking Zero Gravity drape
Standby If needed for touch up post cryo or for redo afib.
Smart touch thermocool STSF DF Smart touch thermocool ST FJ
Perclose x1

Vascade x3

Cables

  • Achieve cable
  • Electrical umbilical cable
  • Coaxial umbilical cable
  • DecNav cable
  • Pentaray cable
  • Quad cable x 2
  • Abalator cable

Procedure (tech)

Pre

Read UCD EP Role for pre and post procedural steps.

  • Include CMAP when patching for phrenic pacing
    • Cable located in C block #31-32
    • Attach alligator clips to patches
  • Set up pressure lines
    • Double spike Hep saline bag under pressure
    • Flush and connect blue pressure to transducer closest to patient on rack (P1)
  • Zero A-line
  • Assist with hooking up
    • Vascular US
    • EP cables
      • Achieve to pin block Blue 1-10
      • Deca nav to Deca
      • His Quad to Quad B (OK to unplug pin block quad plug)

During case

  • Open ablation window on live screen
    • right click in ablation window to change ablator.
    • Check dial for correct ablator.
  • Check that ablation switch behind ablation consoles is set to "Cryo"
  • Physician will place catheters and access LA.
  • Be ready for backup pacing post cardioversion (usually HisD)
  • Measure LA pressure
  • Measure conduction intervals
  • Once Cryo ballon is in LA and ablation starts do the following:
    • Save and label freeze frame of fluoro with location of freeze and ablation number ex: "LUPV Cryo #1" copy this text and save
    • Monitor ablation sequence
    • After ablation ends, record ablation data including copied text to Ablation End log entry comment section ex: "LUPV Cryo #1 180sec -45C"
      • If esophagus temp is affected, record this temp also "23C esoph"
    • EP study is conducted during Cryo ablation phase of procedure
      • Atrial Wenckebach, Atrial ERP, and VERP
    • When phrenic nerve is involved. Prepare to pace CMAP
      • Channel 4 800msec, 25mA
      • When freeze is initiated, come on pacing as temp passes 0C
      • When thawing, come off pacing as temp passes 0C

Procedure (scrub)

Pre

  • Label pressure lines
    • Blue - Transseptal line connected to P1. Swapped to manifold during cryo ablation.
    • Yellow - not transduced connected to flex cath sheath.
    • No color - used for Octaray drip. Keep manifold on table.
    • A-line setup. Pre labeled red. Connects to sheath for act draws.
  • Setup manifold
    • Cap 2 middle ports for Srivasta. No dump bag
    • Position 1 connects to blue pressure line.
  • Position 4 pass off spike for pressurized saline.
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